Dixon v. Williams

Opinion

3 SEANAH J. DIXON Case No.: 2:24-cv-02103-APG-BNW

4 Plaintiff Order Denying Plaintiff Seanah Dixon’s v. Motions for Injunctive Relief 5 [ECF Nos. 2, 3] 6 KENNETH WILLIAMS, et al.,

7 Defendants

9 Seanah J. Dixon is an inmate in the custody of the Nevada Department of Corrections 10 (NDOC) and is currently housed at High Desert State Prison (HDSP). She sues various NDOC 11 employees under 42 U.S.C. § 1983, claiming violations of her First and Eighth Amendment 12 rights. She alleges that the defendants have shown a deliberate indifference to her medical needs 13 and have retaliated against her by delaying and withholding critical medical care, before and 14 after she experienced a stroke and was discharged from the hospital. 15 Dixon moved for a temporary restraining order (TRO) and a preliminary injunction, 16 requesting that I compel the defendants to: 17 (1) immediately facilitate a cardiologist consultation based on her hospital discharge 18 plan, 19 (2) stop its employees from substituting or changing her medications without 20 specialist approval, 21 (3) refer her to “all specialty doctors and conducting all outstanding diagnostic 22 procedures,” and 23 (4) stock necessary medications at HDSP. 1 ECF No. 2 at 3-4 (simplified). NDOC opposed,1 arguing that Dixon is not likely to succeed on 2 the merits of her Eighth Amendment claim because she has failed to exhaust her administrative 3 remedies and because she has not shown that NDOC officials were deliberately indifferent to her 4 medical needs. It also argued that Dixon cannot establish that she will suffer irreparable harm

5 without injunctive relief and that the balance of equities and public interest do not favor me 6 granting it. 7 I previously denied three of Dixon’s four requests for relief. I denied Dixon’s first 8 request for relief as moot and denied her third and fourth requests as not meeting the standards 9 for relief under the Prison Litigation Reform Act. ECF No. 21. I deferred deciding on her second 10 request to stop NDOC employees from substituting or changing her medications without 11 specialist approval because Dixon subsequently filed addenda alleging that NDOC medical 12 providers had stopped two of her discharge prescription medications in January and February 13 2025, which NDOC did not address in its status report. ECF Nos. 20 at 3; 24 at 2-3; 28 at 2. I 14 then ordered the defendants to file a response to my order to show cause and address the alleged

15 stops. ECF No. 31. The defendants responded with an explanation of Dixon’s treatment with 16 respect to her medications. ECF No. 36. Because Dixon has not shown a likelihood of success 17 on the merits of her Eighth Amendment claim, I deny her motions for injunctive relief. 19 To qualify for a temporary restraining order or a preliminary injunction, a plaintiff must 20 demonstrate: (1) a likelihood of success on the merits, (2) a likelihood of irreparable harm, 21 (3) the balance of hardships favors the plaintiff, and (4) an injunction is in the public interest. 22

23 1 At the time the opposition was filed, the Nevada Attorney General’s Office had not yet accepted service for any defendant, so NDOC appeared as an interested party. 1 Winter v. Nat. Res. Def. Council, Inc., 555 U.S. 7, 20 (2008). Alternatively, under the sliding 2 scale approach, the plaintiff must demonstrate (1) serious questions on the merits, (2) a 3 likelihood of irreparable harm, (3) the balance of hardships tips sharply in the plaintiff’s favor, 4 and (4) an injunction is in the public interest. All. for the Wild Rockies v. Cottrell, 632 F.3d 1127,

5 1135 (9th Cir. 2011). Because Dixon seeks a mandatory injunction to require the defendants to 6 take affirmative action, she also must show that “the facts and law clearly favor” her. Garcia v. 7 Google, Inc., 786 F.3d 733, 740 (9th Cir. 2015) (en banc) (quotation omitted). Mandatory 8 injunctions are “particularly disfavored” because they go “well beyond simply maintaining the 9 status quo.” Id. (quotation omitted). 10 As to the merits of an Eighth Amendment claim, “[t]he government has an obligation to 11 provide medical care for those whom it is punishing by incarceration and failure to meet that 12 obligation can constitute an Eighth Amendment violation cognizable under § 1983.” Colwell v. 13 Bannister, 763 F.3d 1060, 1066 (9th Cir. 2014) (quotation omitted). “To establish an Eighth 14 Amendment violation, a plaintiff must satisfy both an objective standard—that the deprivation

15 was serious enough to constitute cruel and unusual punishment—and a subjective standard— 16 deliberate indifference.” Snow v. McDaniel, 681 F.3d 978, 985 (9th Cir. 2012), overruled on 17 other grounds by Peralta v. Dillard, 744 F.3d 1076, 1083 (9th Cir. 2014). 18 To establish the first prong, “the plaintiff must show a serious medical need by 19 demonstrating that failure to treat a prisoner’s condition could result in further significant injury 20 or the unnecessary and wanton infliction of pain.” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 21 2006) (quotation omitted). A medical need qualifies as serious when the inmate has: (1) “an 22 injury that a reasonable doctor or patient would find important and worthy of comment or 23 treatment,” (2) a “medical condition that significantly affects an individual’s daily activities,” or 1 (3) “chronic and substantial pain.” McGuckin v. Smith, 974 F.2d 1050, 1059-60 (9th Cir. 1992), 2 overruled in part on other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 1133 (9th Cir. 1997) 3 (en banc). Where the claim of medical indifference stems from an alleged delay in receiving 4 medical treatment, the prisoner must show that the delay itself led to further injury. See Shapley

5 v. Nev. Bd. of State Prison Comm’rs, 766 F.2d 404, 407 (9th Cir. 1985) (holding that “mere 6 delay of surgery, without more, is insufficient to state a claim of deliberate medical 7 indifference”). 8 “Deliberate indifference is a high legal standard. A showing of medical malpractice or 9 negligence is insufficient to establish a constitutional deprivation under the Eighth Amendment.” 10 Toguchi v. Chung, 391 F.3d 1051, 1060 (9th Cir. 2004). To establish deliberate indifference, a 11 plaintiff must show “(a) a purposeful act or failure to respond to a prisoner’s pain or possible 12 medical need and (b) harm caused by the indifference.” Jett, 439 F.3d at 1096. “Indifference 13 may appear when prison officials deny, delay or intentionally interfere with medical treatment, 14 or it may be shown by the way in which prison physicians provide medical care.” Id. (quotation

15 omitted). “A prison official is deliberately indifferent under the subjective element of the test 16 only if the official knows of and disregards an excessive risk to inmate health and safety.” 17 Colwell, 763 F.3d at 1066 (quotation omitted). “[T]he official must both be aware of facts from 18 which the inference could be drawn that a substantial risk of serious harm exists, and he must 19 also draw the inference.” Farmer v. Brennan, 511 U.S. 825, 837 (1994). 20 When deciding whether an official has been deliberately indifferent to an inmate’s 21 serious medical needs, I “need not defer to the judgment of prison doctors or administrators.” 22 Colwell, 763 F.3d at 1066 (quotation omitted). But a “difference of opinion between a physician 23 and the prisoner—or between medical professionals—concerning what medical care is 1 appropriate does not amount to deliberate indifference.” Id. at 1068 (quotation omitted). Instead, 2 “the plaintiff must show that the course of treatment the doctors chose was medically 3 unacceptable under the circumstances and that the defendants chose this course in conscious 4 disregard of an excessive risk to plaintiff’s health.” Id. (quotation omitted). However, “[a]

5 prisoner need not prove that [s]he was completely denied medical care,” for “[s]he can establish 6 deliberate indifference by showing that officials intentionally interfered with h[er] medical 7 treatment.” Lopez v. Smith, 203 F.3d 1122, 1132 (9th Cir. 2000) (en banc). 9 On October 4, 2024, Dixon was admitted to Spring Valley Hospital for a stroke. ECF No. 10 19-1 at 48. The discharge plan issued by her treating physicians at Spring Valley Hospital 11 included a new prescription for furosemide and an existing prescription for apixaban, both to be 12 taken daily. Id. at 2, 4. The brand name for furosemide is Lasix, and the brand name for 13 apixaban is Eliquis. Id. at 27, 35. According to information included in Dixon’s discharge 14 papers, furosemide is “used to treat fluid retention (edema) in people with congestive heart

15 failure.” Id. at 28. Dixon’s medication list included boilerplate language advising that she should 16 “[t]alk to [her] doctor before stopping any [] medications.” Id. at 4. In her complaint, Dixon 17 alleges that following discharge from the hospital, NDOC medical employees did not provide her 18 with her discharge medications, including furosemide and apixaban, and that their “protracted 19 delay[] in providing her medications . . . subject[ed] her” to a number of serious, adverse health 20 effects. ECF No. 7 at 33-34. 21 NDOC previously did not respond to Dixon’s allegation about not receiving her apixaban 22 and furosemide prescriptions, mentioning only the discharge plan’s order for her “to take aspirin 23 and statins.” ECF No. 10 at 3. It argued that Dixon is unlikely to succeed on the merits of her 1 Eighth Amendment claim because she failed to exhaust her administrative remedies and because 2 the defendants were not deliberately indifferent to her serious medical needs. It contended that 3 Dixon’s “disagreement with the care offered by medical professionals” does not support her 4 claim and that “[s]he does not have the right to direct her own medical care.” Id. at 7. NDOC

5 further contended that Dixon has not shown a likelihood of irreparable harm without injunctive 6 relief, and that neither the balance of equities nor the public interest weigh in her favor. 7 In Dixon’s reply, she initially conceded that she received her furosemide and apixaban 8 prescriptions, though “only . . . after her TRO/PI filing November 13, 2024.” ECF No. 17 at 9. 9 She also included copies of emergency grievances she filed at HDSP after being discharged from 10 the hospital, in which she complained she was not being given furosemide and that she was 11 experiencing breathing issues and chest pains as a result. Id. at 73-78. Specifically, in an 12 emergency grievance dated on October 16, 2024, Dixon stated that “[o]ne of the prescribed meds 13 that helps my failing heart pump fluids off my lungs (“Lasi[x]”) still 8 days later has not been 14 administered to me. I’m havin[g] breathing issues—upper chest pains. I NEED this

15 medication[.]” Id. at 73. The supervisor comment on the grievance form states that Dixon was 16 already on spironolactone. Id. In her complaint, Dixon states that she was “on spiro[no]lactone 17 for 12 years prior to 10/03/24[,] making evident it was ineffective in removing lung fluid.” ECF 18 No. 7 at 31. Her complaint also alleges that by October 21, 2021, she had still not received her 19 furosemide medication and when she complained to an HDSP nurse, the nurse “falsely 20 conclud[ed] after argument that [her] spiro[no]lactone served the same function as her Lasi[x].” 21 Id. at 33. 22 In her second addendum filed on January 29, 2025, Dixon did not allege that the 23 defendants had stopped administering apixaban to her. ECF No. 20 at 3. Thus, I ruled in my 1 previous order that her request for injunctive relief related to apixaban is moot. ECF No. 21 at 6. 2 However, she also alleged in her second addendum that “despite being prescribed furosemide, 3 prior to her January 21, 2025 heart attack[,] said medication had not been administered for in 4 excess of 3 weeks.” ECF No. 20 at 3. The addendum also included a copy of an emergency

5 grievance Dixon filed on January 20, 2025, where she complained of chest tightness and 6 breathing issues, in addition to stating that she “ha[d] not had [her] Lasi[x] meds in over 4 7 weeks.” Id. at 5. 8 On February 6, the defendants submitted a status report. ECF No. 24. They reported that 9 nurse Betty Omandac2 had discontinued Dixon’s furosemide medication on October 23, 2024 10 “for [a] short period for evaluation due to the duplicate therapy with both diuretics” as Dixon 11 was already taking another “diuretic called [s]pironolactone 100mg daily as part of her 12 [h]ormone [r]eplacement therapy.” Id. at 2-3. But Omandac reordered the medication on 13 November 13, 2024 at a reduced frequency for three days of the week, instead of daily, “until 14 [the nurse] receive[d] a recommendation from the [c]ardiologist on whether or not both diuretics

15 should be given together on a daily basis.” Id. at 2. The defendants did not address Dixon’s 16 allegation that they had stopped her furosemide prescription for over three weeks in January 17 2025. On February 13, 2025, Dixon filed a response to the defendants’ status report, stating that 18 “as of the current date[,] defendants have deprived [her] of her cardiologist ordered Eliquis for in 19 excess of a week[,] purposefully failing to reorder it and again without cardiology input.” ECF 20 No. 28 at 2. 21 I then ordered the defendants to file a response to my order to show cause addressing 22 (1) whether NDOC medical providers stopped Dixon’s furosemide/Lasix prescription in January 23

2 Omandac is not a named defendant. 1 2025, and if so, for how long; (2) whether NDOC medical providers stopped her 2 apixaban/Eliquis in February 2025, and if so, for how long; and (3) what medical basis they had 3 for each of the stops. ECF No. 31 at 4. I also requested that they explain what the defendants 4 have done or what they plan to do to obtain a recommendation from a cardiologist on (a) whether

5 NDOC medical providers may safely provide Dixon her preexisting spironolactone prescription 6 along with a daily 20mg furosemide dosage pursuant to her discharge plan prescription from 7 Spring Valley Hospital, and (b) if not, what changes NDOC medical providers should make to 8 her furosemide prescription to make it compatible with her existing hormone replacement 9 therapy regimen. Id. 10 In their response, the defendants state that NDOC medical providers did not stop Dixon’s 11 furosemide/Lasix prescription in January 2025. Rather, the regimen was reduced to three days a 12 week as they previously noted in their status report “based on the medical provider’s opinion that 13 Lasix would exacerbate the properties of other medications Dixon was taking for her gender 14 dysphoria treatment.” ECF No. 36 at 2. They also state that NDOC’s medical department has

15 recently contacted a cardiologist regarding whether it could safely provide Dixon the daily 20mg 16 furosemide dosage along with her existing spironolactone prescription, and that upon 17 cardiologist approval, “there would be no reason not to resume the Lasix to a daily regimen.” Id. 18 The defendants also note that Dixon’s cardiologist requested a loop recording be completed prior 19 to the next appointment, and the case manager nurse has submitted a request for a loop recorder. 20 Id. at 3. Once the recording is completed, NDOC medical providers plan to schedule the follow- 21 up cardiology appointment. Id. 22 Regarding her apixaban/Eliquis prescription, the defendants confirm that NDOC medical 23 providers stopped administration on February 5, 2025 after the Utilization Review Panel (URP) 1 denied a non-formulary request in order to “assess the patient to determine if anti-coagulation 2 therapy was appropriate and if appropriate to refer the patient to the Coumadin clinic.” Id. at 2. 3 She has since “been referred to the Coumadin clinic for management of her blood thinning 4 treatment.” Id. Dixon thereafter filed another addendum and various exhibits, alleging that

5 defendant Kenneth Williams had been making “substantial adverse medical decisions in [her] 6 clinical case” without a medical license, including discontinuing her apixaban medication. ECF 7 Nos. 37 at 3; 38; 39; 41. 9 Dixon has established her serious medical need. Dixon’s discharge documents from 10 Spring Valley Hospital confirm that she experienced an acute cerebral ischemia, for which she 11 was hospitalized, treated, and ordered to adhere to post-discharge medications and treatments, 12 including a daily 20mg dosage of furosemide. ECF Nos. 10 at 3; 19-1 at 2-4, 48. A stroke is a 13 condition that a reasonable doctor or patient would find important and worthy of treatment. See 14 McGuckin, 974 F.2d at 1059-60. Following discharge from the hospital, Dixon filed multiple

15 emergency grievances complaining that she had not received her furosemide prescription, as well 16 as reporting serious chest pain and breathing issues in those periods that she was deprived of the 17 medication. ECF Nos. 17 at 73; 20 at 5. In her complaint, she states that these “protracted delays 18 in providing her medications[] expos[ed] and subject[ed] her to wantonly immense terror and 19 sufferings, heart attacks, [and] strokes.” ECF No. 7 at 34. In her second addendum, she alleges 20 that she was not provided her prescription for over three weeks before she experienced a heart 21 attack on January 21, 2025. ECF No. 20 at 3. Thus, she is not alleging a mere delay in treatment, 22 but has presented evidence that the delay in receiving her medication has caused her further 23 injury. 1 However, Dixon has not met her burden of showing it is likely that she will succeed on 2 the merits regarding deliberate indifference given the medical bases for her current course of 3 treatment. The NDOC medical providers have denied stopping the furosemide medication since 4 restarting it in November. They state they have instead administered a reduced regimen due to

5 concerns of “exacerbat[ing] the properties of other medications [(spironolactone)] Dixon was 6 taking for her gender dysphoria treatment.” ECF No. 36 at 2. The medication list the hospital 7 provided as part of Dixon’s discharge plan does not list spironolactone as one of her 8 “unchanged” medications, unlike apixaban, which is listed. ECF No. 19-1 at 4. This suggests a 9 possibility that her Spring Valley Hospital medical providers might not have been aware of her 10 preexisting spironolactone prescription when prescribing a daily regimen of furosemide. In any 11 case, NDOC medical providers have also submitted a request for a loop recorder, plan to 12 schedule a follow-up appointment with her cardiologist after completing the recording as 13 requested by the cardiologist, and have indicated they are willing to restore her furosemide 14 prescription back to a daily dosage once they receive approval from the cardiologist to do so.

15 While the medical providers have stopped the apixaban prescription, they did so on the decision 16 of the URP, which sought to assess whether continuing anti-coagulation therapy would be 17 appropriate for Dixon. ECF No. 36 at 2. As an alternative course of treatment, Dixon’s providers 18 have since referred her to the Coumadin clinic to manage her blood thinning treatment. Id. 19 Dixon does not point to any other evidence that the alternative treatment plans devised by 20 the NDOC medical providers are medically unacceptable under the circumstances and chosen in 21 conscious disregard of an excessive risk to her health. Nor has she shown a likelihood that these 22 decisions regarding her medication are “more than a difference of medical opinion as to the need 23 to pursue one course of treatment over another.” Wilhelm v. Rotman, 680 F.3d 1113, 1122 (9th 1} Cir. 2012) (quotation omitted). While Dixon alleges that defendant Kenneth Williams has made decisions regarding her care without a medical license, including discontinuing her apixaban prescription, the defendants previously noted in their latest response that the decision against renewal was made by the URP, a “group made up of all of the providers in the NDOC system,” just Williams. /d. at 2-3. Dixon does not argue that all the URP members made their recommendations without being licensed. 7 Because it appears unlikely that Dixon will succeed on her Eighth Amendment claims, I 8]| deny her request for injunctive relief to stop NDOC medical providers from substituting or changing her medications without specialist approval. 11 I THEREFORE ORDER plaintiff Seanah J. Dixon’s motions for injunctive relief (ECF 12|| Nos. 2, 3) are DENIED. 13 DATED this 13th day of March, 2025. 14 ge— ANDREWP.GORDON. 16 CHIEF UNITED STATES DISTRICT JUDGE

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